Thanks for signing up! You might also like these other newsletters:

WEDNESDAY, Feb. 27, 2013 —Women throughout the world are at risk for breast cancer, which means screening for the disease is essential, regardless of what country you happen to live in. Even still, opinions differ on when women should begin routine mammography, which experts say is one of the most crucial ways to cut the risk of breast cancer death.

A New England Journal of Medicine report just published finds that doctors throughout the world have varying opinions on mammography guidelines. Their report is based on a survey of the journal's readers, who are physicians in North America, Europe, Central and South Africa, and Asia. They asked the physicians whether they thought routine mammograms should begin at age 40 or 50, or whether they felt routine screening is not essential to cut down on breast cancer mortality rates.

Among all 1,240 physicians who participated in the survey, 39 percent believed screening should begin by age 40, while 44 percent felt that 50 is the most appropriate age to start, and 17 percent said they didn't think routine mammography is necessary for preventing incidences of breast cancer.

A little more than a quarter of European doctors surveyed felt routine screenings were not necessary, compared to 14 percent of doctors in North America. Among all of the regions, Central and South American physicians were most likely to report that screenings should begin at age 40.

James Colbert, MD, an editorial fellow who coauthored the paper and practices internal medicine at Wellesley-Newton Hospital, believes physicians sometimes may not be up-to-date on the most recent guidelines for screening. "Breast cancer tends to be a disease of more developed countries," he says. "In developed countries we're better able to prevent communicable diseases, and parasitic disease, as well as HIV. If you're able to live to a ripe old age, those are the people who are going to be more at risk for developing breast cancer."

Breast cancer is the most diagnosed cancer among women worldwide. In 2008, there were an estimated 458,500 deaths – nearly 1 in 7 or around 14 percent of all cancer deaths among women, according to the organization Cancer Research UK. Disease incidences vary throughout the world. In 2010, Western Europe had the highest incidence rate at 90 per 100,000 women, while Eastern Africa has the lowest incidence rate at 19 per 100,000 women. North America has the fourth highest incidence rate at around 77 per 100,000 women, according to the Susan G. Komen Breast Cancer Foundation.

Economic and Cultural Factors

In general, developed countries, such as United States, tend to have a higher incidence of breast cancer, but also a higher survival rate from the disease. While in developing nations, such as parts of Africa, the incidence rate for breast cancer is low but the survival rate is also low.

Breast cancer survival rates are influenced by a number of cultural and socioeconomic factors. Some experts say the high incidence rate for breast cancer in westernized nations may be attributed to a diet heavy on salt, fat, and processed food, as well as a more sedentary lifestyle. Other experts say that having children later in life and shorter period of breastfeeding — more common in Westernized nations — increases one's risk for developing the disease. In less developed regions of the world, the lack of of health care access makes screening for breast cancer a challenge, since many women seek medical attention when the cancer is more advanced.

In developing countries, you’re going to present later in general. There’s no access to primary care. By that time breast cancer is diagnosed it will be metastatic, notes Dr. Colbert.

Guideline Differences in Westernized Nations

In the United States, when to begin breast cancer screening has long been a contentious issue. The U.S. Preventive Services Task Force sparked controversy in 2009, when they revised their guidelines, recommending women begin routine mammograms beginning at the age of 50 instead of 40. However, many organizations, such as the American Cancer Society continue to stand by the opinion that screening for breast cancer should start at the age of 40.

In other parts of the Western world, breast cancer screening is not conducted every year. For a large part, Europe remains skeptical of the usefulness of regular mammograms. In the United Kingdom, the National Health Service, the nation's health care agency, only covers breast cancer screening for women ages 47 to 73, according to organization Cancer Research UK. Women are sent an invitation every three years for an annual mammogram and around 75 percent go for screening.

But most experts, wherever they may be in the world, agree that the frequency of screenings should not be determined by where a woman lives, but rather the various factors that put a woman at risk for developing the disease. These include whether or not she has had children, if she has gone through menopause, has a family history of breast cancer, or is obese. " I think it’s a mistake to look at the data and conclude that there’s one right answer that should be the needs of all women. Each case is different. It’s about trying to assess the individual’s risk," says Colbert.